A parasite outbreak linked to shredded iceberg lettuce from Mexico has expanded to three more states and sickened more than 11,000 people. Cases of cyclosporiasis tied to the contaminated lettuce have now been reported in Georgia, Tennessee and Texas, bringing the total number of affected states to 20.
The Centers for Disease Control and Prevention and the Food and Drug Administration are investigating the outbreak. The illness has sickened 11,458 people and caused two deaths, an increase from the 10,900 cases reported last week.
Cyclospora is a parasite that causes cyclosporiasis, a gastrointestinal infection that leads to sudden and painful diarrhea. The CDC and FDA are currently investigating multiple outbreaks of the parasite across the country.
Lettuce recall and distribution
The infections have been traced to iceberg lettuce processed by Taylor Farms de Mexico, a central Mexico-based processor. The CDC said epidemiologic and traceback data showed the lettuce was contaminated with cyclospora. The FDA classified the recall of the lettuce as Class I last week, which is its highest risk level. The agency defines this classification as "a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death."
The recalled lettuce was distributed to 27 states. These include Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
The outbreak was first identified in July and initially linked to shredded lettuce served at certain Taco Bell restaurants. People who became ill reported exposure to iceberg lettuce from Taylor Farms served or purchased at various locations, including Taco Bell. Following the initial reports, Taco Bell stopped using lettuce in its menu items.
Taylor Farms response
Shortly after the outbreak was identified, Taylor Farms voluntarily recalled iceberg lettuce grown in Mexico. It was later revealed that a positive test result for cyclospora in a sample of the company's lettuce was a false-positive. The company has stated that no further testing of its products has detected the pathogen.
Despite this, health officials maintain that the produce is the source of the outbreak. Acting FDA Commissioner Kyle Diamantas told CNBC earlier this month that the agency is "very confident that the iceberg lettuce from central Mexico was the culprit." No other potential source has been named or confirmed.
In a statement released at the time of the recall, Taylor Farms said that no Taylor Farms branded salads or kits are associated with the outbreak. The company emphasized that its branded salad kits do not contain iceberg lettuce.
"As a family-owned and operated company, we are deeply concerned for those who became ill, their families, and the many Americans whose trust in the safety of their fresh produce has been shaken," the company said. "That trust is something we’ve worked for decades to earn, and we are committed to doing everything in our power to restore that confidence."
The company noted that the FDA traceback indicated a specific independent farm representing less than 1 percent of the iceberg lettuce supply in the United States. Based on information from the FDA, Taylor Farms de Mexico removed all iceberg lettuce sourced from central Mexico indefinitely.
National cyclospora cases
Health agencies have attempted to reassure the public about the food supply. Diamantas stated that the FDA "remains confident that all iceberg lettuce related to the cyclospora outbreak has been effectively removed from the market." The Department of Health and Human Services posted on social media: "Cyclospora: contained, American food: safe."
The CDC notes on its surveillance page that it is investigating multiple clusters of the infection, which includes the large multistate outbreak linked to the processed Mexican iceberg lettuce.
Across the United States, there are currently record locally acquired numbers of the infection. There are at least 17,180 confirmed cases overall, with nearly 12,000 additional cases still under investigation. These national figures include 922 hospitalizations and two deaths, with cases reported in 48 states and Washington, DC.
The CDC has indicated that the outbreaks may not be limited to the states currently reporting them. The agency said the true number of cases is likely higher, as not everyone infected with cyclosporiasis receives testing or treatment. The time required to investigate and link cases to an active outbreak also results in delays of case counts.
